The effects of delivery format on the effectiveness and acceptability of self-guided interventions for depression in older adults: A systematic review and meta-analysis

Abstract

Self-guided interventions could improve the availability of evidence-based psychotherapies for late-life depressive symptoms. However, their treatment outcomes and acceptability across delivery formats remain uncertain. This review aimed to examine the effectiveness and acceptability of self-guided intervention for older adults with depressive symptoms and the impact of different intervention features. Randomised controlled trials included older adults (mean age ≥ 60 years) with elevated depressive symptoms who received self-guided interventions for depression were eligible. Trials were extracted from an existing database and updated systematic literature searches in PubMed, PsychINFO, Embase, and Cochrane Library (last update: 20th Mar 2025). Data were synthesised with random-effects meta-analysis, subgroup analysis, and meta-regressions. Outcomes included depressive symptoms, quality of life, and dropout rates. Seven studies with 1170 participants were identified. Compared to controls, self-guided interventions had small-to-moderate effect in reducing depressive symptoms at post-treatment (g = 0.46, 95 % CI 0.20 to 0.73), but the effect was not sustained at 3-to-12-month follow-up (g = 0.15, 95 % CI –0.45 to 0.74). Effects on quality of life remains inconclusive. Acceptability was comparable between self-guided interventions and control conditions (RR = 1.52, p = .294). No differences in treatment effects and acceptability were observed across delivery formats, support levels, or initial human screening. Most studies showed a moderate-to-high risk of bias (n = 6). Self-guided interventions for depression were associated with reductions in depressive symptoms and were acceptable to older adults, regardless of delivery format and level of human support. They may be considered a brief intervention option in resource-limited setting.